Conceptual, Methodological, and Ethical Problems in Communicating Uncertainty in Clinical Evidence
Medical Care Research and Review (Impact Factor: 2.62). 11/2012; 70(1 Suppl). DOI: 10.1177/1077558712459361
The communication of uncertainty in clinical evidence is an important endeavor that poses difficult conceptual, methodological, and ethical problems. Conceptual problems include logical paradoxes in the meaning of probability and "ambiguity"-second-order uncertainty arising from the lack of reliability, credibility, or adequacy of probability information. Methodological problems include questions about optimal methods for representing fundamental uncertainties and for communicating these uncertainties in clinical practice. Ethical problems include questions about whether communicating uncertainty enhances or diminishes patient autonomy and produces net benefits or harms. This article reviews the limited but growing literature on these problems and efforts to address them and identifies key areas of focus for future research. It is argued that the critical need moving forward is for greater conceptual clarity and consistent representational methods that make the meaning of various uncertainties understandable, and for clinical interventions to support patients in coping with uncertainty in decision making.
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- "Similarly, Afifi and Morse (2009) suggested that when reflecting on the perceived discrepancy between one's desired and current states of uncertainty, people either reduce uncertainty, maintain uncertainty, or reevaluate their discrepancy based on their self-efficacy 40 for managing uncertainty. Although health care patients frequently experience uncertainty, physicians also experience uncertainty when treating patients (Fox, 1957; Hall, 2002; Han, 2013). The current study investigates the most compelling ways in which 45 physicians, specifically obstetricians, manage uncertainty in the context of medical decision making, particularly when multiple options for care exist. "
ABSTRACT: The study investigated numerous complexities in medical-decision making among obstetricians treating high-risk or complex pregnancies. Obstetricians in a Southeastern state were interviewed (N = 28) using a guide based on the framework of Message Convergence. The study assessed how the physicians manage uncertainty surrounding patient care and engage in medical decision-making in the midst of either unclear evidence or competing messages. As a result, the study found that message convergence plays a notable role in the obstetricians' clinical decision-making. Conclusions and practical recommendations are provided, and theoretical extensions to the Message Convergence Framework in the clinical and communicative practices of the physicians are also advanced.
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- "In other clinical arenas, important choices patients make are frequently based on a shared decision-making model in which patients and clinicians discuss available facts and share personal preferences and values. A trusting relationship in which the clinician knows the patient as a person, and understands her values, experiences and informational needs is central to shared decision-making (Epstein and Gramling 2013; Han 2013). When there are uncertainties relating to potential outcomes, shared decision-making can promote patient autonomy through a patient-clinician partnership aimed at helping patients achieve clarity about their preferences in the face of complexity, inadequate evidence, and irreducible uncertainty. "
ABSTRACT: Because of the higher yield over traditional chromosomal analysis, chromosomal microarray analysis (CMA) is being used increasingly in prenatal diagnosis. Unfortunately, the clinical implication of many copy number variants found on prenatal CMA is uncertain, complicating genetic counseling. Recognizing that uncertain results will be encountered frequently as more of the genome is assayed prenatally, we set out to understand the experiences and needs of genetic counselors when counseling patients about uncertain prenatal microarray results, their comfort with various aspects of prenatal genetic counseling, and their interest in additional education and training about prenatal microarray testing. We first interviewed 10 genetic counselors about their experiences of providing pre- and post-test genetic counseling about prenatal CMA. Based on the findings from the counselor interviews, we developed items for a survey to assess the prevalence of genetic counselors' attitudes towards, experience and comfort with, and educational needs regarding prenatal CMA. Based on surveys completed by 193 prenatal genetic counselors, we found that when there is an uncertain CMA result, only 59 % would be comfortable providing genetic counseling and only 43 % would be comfortable helping a patient make a decision about pregnancy termination. Being less comfortable was associated with seeing fewer patients having prenatal CMA testing. Respondents expressed a high degree of interest in additional education about prenatal CMA and counseling about uncertain results. Further genetic counselor education and training aimed at improving counselors' personal comfort with uncertain results and communicating about them with patients is needed.
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- "All of these reactions raise questions about logic and timing in communicating uncertainty. Of course, only the aggregation of numerous studies across different contexts, time intervals, and forms of uncertainty will yield generalizable knowledge to guide effective communication practice [7,8,33,34]. "
ABSTRACT: In 2009, the U.S. Preventive Services Task Force released new mammography screening guidelines that sparked a torrent of criticism. The subsequent conflict was significant and pitted the Task Force against other health organizations, advocacy groups, the media, and the public at large. We argue that this controversy was driven by the systematic removal of uncertainty from science communication. To increase comprehension and adherence, health information communicators remove caveats, limitations, and hedging so science appears simple and more certain. This streamlining process is, in many instances, initiated by researchers as they engage in dissemination of their findings, and it is facilitated by public relations professionals, journalists, public health practitioners, and others whose tasks involve using the results from research for specific purposes. Uncertainty is removed from public communication because many communicators believe that it is difficult for people to process and/or that it is something the audience wants to avoid. Uncertainty management theory posits that people can find meaning and value in uncertainty. We define key terms relevant to uncertainty management, describe research on the processing of uncertainty, identify directions for future research, and offer recommendations for scientists, practitioners, and media professionals confronted with uncertain findings. Science is routinely simplified as it is prepared for public consumption. In line with the model of information overload, this practice may increase short-term adherence to recommendations at the expense of long-term message consistency and trust in science.
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